Muscat: Muslims are passionate about fasting during the month of Ramadan as it is one of the five pillars of Islam. The Holy Quran exempts the sick, ailing and frail people from fasting, but people with diabetes may not think they are sick, so they fast, too.
This year Ramadan has coincided with the peak of summer and the devout are observing the fast for a minimum of 15 hours. Diabetics who fast might be at a risk of low sugar which is dangerous for them.
Diabetes patients are at a risk of high sugar, low sugar, acute sugar complications, blood stickiness and severe dehydration during fasting.
Patients who might face very serious consequences from fasting include those with:
-- History of very low sugar within the last three months prior to Ramadan
-- History of very high sugar crisis within the last three months prior to Ramadan
-- History of repeated incidences of low sugar
-- Who can't feel low sugar symptoms due to defective counter regulatory mechanisms
-- Who have uncontrolled blood sugar for a long time
-- Patients with type-1 diabetes
-- Those suffering from any form of sudden onset of illness
-- Who have to perform intense physical labour
-- Pregnant and breast feeding mothers
-- Those who are on dialysis due to kidney failure
Patients who might face serious consequences:
-- Those who have moderately high sugar
-- Having diabetic kidney disease
-- Having advanced heart disease, brain or diabetic foot disease
-- Living alone and on insulin or long acting oral glucose lowering tablets
-- Those with other major systemic diseases
-- Those with old age and generalised ill health
-- Those on some drugs that affects mental alertness
Patients who might be vulnerable due to adverse effects of their medications:
-- Patients who are on particular types of anti-diabetic drugs
-- Patients who are less likely to have any adverse effects from fasting:
-- Patients who are on diets alone or some other particular anti-diabetic drugs
Diabetics who want to fast during Ramadan should manage their approach individually. Each patient has different status of glucose control, blood pressure, abnormal fat level and other factors that will determine how they should fast.
Daily sugar check-up
Patients should have a glucometer to check blood sugar several times daily. This is crucial for those suffering with type-1 diabetes and type-2 — those are on insulin.
Luckily, the glucometer uses just a small drop of blood so it won't break the fast.
In Islam, a drop of blood that can free fall from the body to ground will cause a break in fasting.
During Ramadan the diet should be balanced and healthy. Taking a large amount of carbohydrate and fat rich food at sunset meal is common but these fat-rich foods delay digestion, so blood sugar levels take time to return to normal after a whole day of fasting. Simple carbohydrates are more suitable at iftar but suhoor should contain complex carbohydrates which take a longer time to digest.
Strenuous exercise will do more harm than good, so normal levels of physical activity can be maintained. Exercise should be done after Iftar to avoid low sugar. 'Taraweeh' prayers can be considered physical activity as there are multiple prayers for long period to perform.
If the blood sugar reading comes down to < 3.3 mmol/L (60 mg/dL), patients should immediately break their fast.
The author is a diabetologist at Dr. Mohan's Diabetes Specialties Centre, 18th November Street, Azaiba. He can be contacted at 24496967, 24613136, firstname.lastname@example.org